The oral contraceptive pill (OCP), or "the pill" for short, is one of the most popular methods of contraception used in Malta. Currently, it's only available for women, although a male pill is being developed.
What happens during a woman's menstrual cycle?
A woman has two ovaries and each contains thousands of immature eggs. Every month, hormones cause a few of these eggs to start ripening, until one, or very occasionally two, gets released into the uterine tubes. This is ovulation. The egg travels down the tubes into the uterus. If it happens to meet a sperm cell, it can combine to form a fertilised egg.
Meanwhile, the wall of the uterus starts to thicken. New blood vessels start forming under the surface to provide a suitable cushion for a possible pregnancy. Hormones from the released egg itself maintain this thick lining.
If there's no fertilisation, the egg continues down its passage in the uterus and gets lost. Once there's no more hormone supply from the egg, the thick uterine wall starts breaking down and sheds blood, giving rise to the woman's monthly period.
Different hormones are at play during this cycle which happens approximately every 28 days.
What is the pill?
The contraceptive pill contains one or two hormones that stop ovulation, or release of the egg, and prevents pregnancy. If taken properly, it prevents pregnancy in about 99% of women, but since accidents happen and sometimes pills are missed, it is about 91% effective in real life.
There are two main types of contraceptive pills.
Combined Oral Contraceptives (COCs) contain two hormones - an oestrogen and a progestogen - and include Adele, Yaz, Yasmin, Yasminelle, Mercilon, Nelya, Vreya, and Qlaria. These are taken every day but need a 7 or 4 day break every month.
Progestogen-Only Pills (POPs - also known as mini-pill) contain only one hormone - a progestogen (called desogestrel). Lamya is a mini-pill that is available in Malta, and abroad it is known as Cerazette. It is taken every day with no break. Mini-pills may be less effective than combined pills at preventing pregnancy, especially if a pill is taken late.
Where can I get the contraceptive pills in Malta?
See your doctor (GP or gynaecologist) for a prescription for contraceptive pills. You can get a repeat prescription; in Malta, this means it's valid for 6 months or 12 months. You can buy the contraceptive pills with a doctor's prescription at any pharmacy in Malta and Gozo. Once your prescription expires, see your doctor again to have it renewed.
The contraceptive pill usually costs 8 to 12 Euros per month, depending on the brand.
How is the pill taken?
For combined oral contraceptive pills (COCs):
Each monthly pack of combined oral contraceptives usually has 21 tablets that contain hormonal therapy. Some brands have packs with 21 hormonal tablets and 7 blank (or placebo) tablets. Other brands have different proportions of hormonal and blank tablets, such as 24 hormonal tablets and 4 blanks. Blank tablets may have a different colour than the hormonal tablets.
Take all the tablets, one by one, until the pack finishes. If you're taking a 28-day pack, start a new pack as soon as one finishes. If your pack contains 21 tablets, take seven pill-free days before starting a new pack. Be sure to remember to start again after the seven days or you may become pregnant.
During your hormone-free break, you can expect bleeding like a light period.
For the Progestogen-only Pill (POP) or mini-pill:
The mini-pill Lamya is taken every day with no break. Each pack contains 28 pills, and when it finishes you should start another one straight away. You may experience some spotting while using the mini-pill.
You need to take the pill every day at the same time. This is very important especially with the mini-pill.
If you find it difficult to remember to take the pill, setting a regular alarm on your phone could help.
If you have any difficulty or you're unsure how to take your pill, ask your doctor or pharmacist for advice. They'll be more than willing to explain how to take it.
What if I forget to take a pill?
For combined oral contraceptive pills (COCs):
It is considered a missed pill if you delay the dose by more than 12 hours. Check the patient information leaflet with the pack or speak to your pharmacist if you're unsure what is the time window before the pill loses efficacy.
If you miss one pill, take it as soon as you remember, even if you have to take two pills at one go. You will still be protected against pregnancy if you miss only one pill.
If you've missed two or more pills, real the patient information leaflet for advice on what to do, or seek your doctor's advice. When you miss two or more pills you will be at risk of pregnancy, so be sure to use condoms if you have intercourse in the next seven days and don't wish to become pregnant. If you recently had intercourse and you missed two or more pills, consider using a morning after pill.
For the progestogen-only pill (POP) or mini pill:
The mini pill is considered a missed pill if you delay the dose by more than 3 hours (or 12 hours if the active ingredient of your mini pill is Desogestrel). Unlike combined pills, you will be at risk of pregnancy if you miss even one mini pill. Take the mini pill as soon as you remember and then use condoms for the next 2 days. If you recently had intercourse, consider using a morning after pill.
What could cause the pill to stop working?
If you have vomiting or diarrhoea, the pill may not be absorbed properly and it may stop working. You should use other contraceptives, such as a condom, during these times.
Some medications, such as certain antibiotics and medicines against seizures, could also stop the pill from working. Always tell you doctor that you are on the pill before they give you other medications.
If you use the morning after pill, the regular contraceptive pill may not work for the rest of that month and you should use a condom as well.
Are there any side effects?
Yes, as with any other medication, but not all women get them. Some women may feel some nausea, bloating or headaches. These usually go away after the body adjusts to the medicine.
If you feel that you're getting side effects from the pill, check with your doctor to see if there's anything you can do about it. Sometimes changing the brand or type of pill helps. You can also choose a different contraceptive that suits you better.
Can the pill be used as a treatment?
Yes, the pill is used very frequently to treat many conditions. These include ovarian cysts, acne and irregular cycles.
What are the advantages of taking the pill as a contraceptive?
The combined oral contraceptive pill helps periods become regular and predictable, and in some women in makes them lighter and less painful. The pill can also reduce the symptoms of pre-menstrual syndrome (PMS).
There are studies that show the pill can protect the woman against certain diseases such as ovarian cancer and benign breast lumps. This protection may last up to 15 years after the pill is stopped.
The pill is widely available in Malta and once you have a prescription it is easy to obtain from pharmacies.
Are there any disadvantages to using the pill?
The pill doesn't protect you against sexually transmitted infections (STIs). Therefore, you should also use a condom if there is a risk of infection.
The pill is also not suitable for women who have a history of uncontrolled high blood pressure, conditions that increase clotting, and thromboses. Your doctor will help you decide whether the pill is suitable for you.